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SITE ADDRESS <br />��,13 <br />LEGAL LOT NO� <br />DESC. `7 Z � <br />OWNER <br />1 )f�'l � <br />TENANT NAME <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />C�2.4Ni� -�y�^ �p`y 3���,/5�7�U(��L� <br />��+- � BLOCK TRACT OR SUBDIVISION # <br />C�-r S �= �1�%�t-�T f ( r� � <br />ADDRESS CITY/ZIP <br />i=�fi �1� � t�-�i�' � lZs �%!.- -Z(�: � s Ur�.,,4,�� n./—�u� �u��,�' <br />I CONTACT FOR PERMIT PHONE <br />PERMIT # <br />� <br />i;�;��0 7-Cc�� <br />PHONE Zb� c� � 3 5�1c� <br />�(�'Z �� 1 <br />� E-MAIL <br />CONTRACTOR �N` ADDRESS CITY/ZIP PHONE <br />��kC i �"tC [�Ak'A(�C 5 <br />Z7 Z�. �'�: C`� �.�= /-�°.; � r�l �� � 1 �-! Y Z�` 1 y L� Z s`i ' 1��/ <br />CONTR. LICENSE # � � ' <br />`T '� � F-�� (�j c� v . j�-: <br />USE OF BUILDING <br />�� �� <br />WORK DESCRIPTION <br />HEAT SOURCE <br />Electric _ Gas _ Other <br />c <br />.�- _ �-,� �,�' ��c.� � ��z____ <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer , <br />Water heater <br />Sink (service/b�r/mop/etc.) <br />Backflow pre4enter <br />Urinal ;' <br />Drinking ountain <br />Floor ain <br />Gre e trap <br />Ro`bf drains <br />Other <br />NO. <br />CONTRACT PRICE OF WORK <br />�. `� ::- �„�.�-��- <br />i <br />zd � l � <br />, <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exh�ust fan <br />HQat pump ��j <br />�nit heater <br />Boiler 5;U <br />Refrigeration � <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractor aw 27 R W and 296.200 WAC. <br />�� �� �/ � �� � <br />Signature of Owner/Co <br />ent <br />Date <br />rIZ <br />